Pediatric CT: Implementation of ASIR for Substantial Radiation Dose Reduction while Maintaining Pre-ASIR Image Noise

Abstract

Purpose-To determine a comprehensive method for the implementation of adaptive statistical iterative reconstruction (ASIR) for maximal radiation dose reduction in pediatric computed tomography (CT) without changing the magnitude of noise in the reconstructed image or the contrast-to-noise ratio (CNR) in the patient.Materials and Methods-The institutional review board waived the need to obtain informed consent for this HIPAA-compliant quality analysis. Chest and abdominopelvic CT images obtained before ASIR implementation (183 patient examinations; mean patient age, 8.8 years ± 6.2 [standard deviation]; range, 1 month to 27 years) were analyzed for image noise and CNR. These measurements were used in conjunction with noise models derived from anthropomorphic phantoms to establish new beam current-modulated CT parameters to implement 40% ASIR at 120 and 100 kVp without changing noise texture or magnitude. Image noise was assessed in images obtained after ASIR implementation (492 patient examinations; mean patient age, 7.6 years ± 5.4; range, 2 months to 28 years) the same way it was assessed in the pre-ASIR analysis. Dose reduction was determined by comparing size-specific dose estimates in the pre-and post-ASIR patient cohorts. Data were analyzed with paired t tests.Results-With 40% ASIR implementation, the average relative dose reduction for chest CT was 39% (2.7/4.4 mGy), with a maximum reduction of 72% (5.3/18.8 mGy). The average relative dose reduction for abdominopelvic CT was 29% (4.8/6.8 mGy), with a maximum reduction of 64% (7.6/20.9 mGy). Beam current modulation was unnecessary for patients weighing 40 kg or less. The difference between 0% and 40% ASIR noise magnitude was less than 1 HU, with statistically Address correspondence to S.L.B. (samuel.brady@stjude.org). 2 Current address: Department of Physics, Tuskegee University, Tuskegee, Ala.Online supplemental material is available for this article. Author contributions:Guarantors of integrity of entire study, S.L.B., R.A.K.; study concepts/study design or data acquisition or data analysis/ interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; manuscript final version approval, all authors; literature research, S.L.B., B.M.M., B.S.Y.; clinical studies, all authors; experimental studies, all authors; statistical analysis, S.L.B.; and manuscript editing, all authors Conflicts of interest are listed at the end of this article. Disclosures of Conflicts of HHS Public Access Author ManuscriptAuthor Manuscript Author ManuscriptAuthor Manuscript nonsignificant increases in patient CNR at 100 kVp of 8% (15.3/14.2; P = .41) for chest CT and 13% (7.8/6.8; P = .40) for abdominopelvic CT.Conclusion-Radiation dose reduction at pediatric CT was achieved when 40% ASIR was implemented as a dose reduction tool only; no net change to the magnitude of noise in the reconstructed image or the patient CNR occurred.Reducing radiation dose for pediatric patients undergoing computed tomography (CT) exami...

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